Biomarkers of Health and Healthy Ageing from the Outside-In

  • Jonathan ShollEmail author
  • Suresh I. S. Rattan
Part of the Healthy Ageing and Longevity book series (HAL, volume 10)


Understanding the phenomenon of health is crucial for ageing research since there is often an implicit view on what constitutes health and how to measure it. We provide some reflections on how we might better understand and measure health, discuss the basic biological principles of survival, ageing, age-related diseases and eventual death, and end by tying these ideas together to rethink the nature of and implications for healthy ageing. We defend a more positive view on health understood in terms of various phenotypic parameters, such as robustness and resilience, and show how it relates to the aim to support these parameters over time to achieve healthy ageing. Together, these ideas suggest that the most effective strategies for healthy ageing may come from the outside-in by altering those aspects of the environment that prevent robust and resilient phenotypic responses and by supporting those aspects which ensure such responses.


Lifespan Healthspan Stress Longevity Health Robustness 


  1. Boorse C (1997) A rebuttal on health. In: Humber JM, Almeder RF (eds) What is disease? Humana Press, Totowa, pp 3–134Google Scholar
  2. Canguilhem G (1991) The normal and the pathological. Zone Books, New YorkGoogle Scholar
  3. Cannon W (1929) Organisation for physiological homeostasis. Physiol Rev 9:399–431CrossRefGoogle Scholar
  4. de Grey ADNJ (2006) Forseeable pharmaceutical repair of age-related extracellular damage. Curr Drug Targets 7:1469–1477CrossRefGoogle Scholar
  5. Dubos R (1965) Man adapting. Yale University Press, New HavenGoogle Scholar
  6. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D et al (2011) How should we define health? BMJ 343:d4163CrossRefGoogle Scholar
  7. Jensen UJ (1987) Practice and progress: a theory for the modern health-care system. Blackwell-Scientific, OxfordGoogle Scholar
  8. Kingma E (2014) Naturalism about health and disease: adding nuance for progress. J Med Phil 39:590–608CrossRefGoogle Scholar
  9. Kirkwood TBL (2008) A systematic look at an old problem. Nature 451:644–647CrossRefGoogle Scholar
  10. Kitano H (2004) Biological robustness. Nature Genet 5:826–837CrossRefGoogle Scholar
  11. Kitano H (2007) Towards a theory of biological robustness. Mol Syst Biol 3:137CrossRefGoogle Scholar
  12. Kresser C (2017) Unconventional medicine, Lioncrest PublishingGoogle Scholar
  13. Lemoine M (2015) The naturalisation of the concept of disease. In: Lambert G, Silberstein M, Huneman P (eds) Classification, disease and evidence: new essays in the philosophy of medicine. Springer, Amsterdam, pp 19–41Google Scholar
  14. Lenart P, Bienertova-Vasku J (2017) Keeping up with the red queen: the pace of aging as an adaptation. Biogerontology 18:693–709CrossRefGoogle Scholar
  15. Marmot M (2015) The heath gap: the challenge of an unequal world. Bloomsbury, LondonGoogle Scholar
  16. Martin GM (2002) Keynote: mechanisms of senescence—complificationists versus simplificationists. Mech Ageing Dev 123:65–73CrossRefGoogle Scholar
  17. McEwen BS, Wingfield JC (2003) The concept of allostasis in biology and biomedicine. Horm Behav 43:2–15CrossRefGoogle Scholar
  18. Odling-Smee FJ (2003) Niceh construction: the neglected process in evolution. Princeton University Press, PrincetonGoogle Scholar
  19. Rattan SIS (1995a) Ageing—a biological perspective. Mol Aspects Med 16:439–508CrossRefGoogle Scholar
  20. Rattan SIS (1995b) Gerontogenes: real or virtual? FASEB J 9:284–286CrossRefGoogle Scholar
  21. Rattan SIS (2006) Theories of biological aging: genes, proteins and free radicals. Free Rad Res 40:1230–1238CrossRefGoogle Scholar
  22. Rattan SIS (2007) Homeostasis, homeodynamics, and aging. In: Birren J (ed) Encyclopedia of gerontology. Elsevier Inc., UK, pp 696–699CrossRefGoogle Scholar
  23. Rattan SIS (2013) Healthy ageing, but what is health? Biogerontology 14:673–677CrossRefGoogle Scholar
  24. Rattan SIS (2015) Biology of ageing: principles, challenges and perspectives. Rom J Morphol Embryol 56:1251–1253PubMedGoogle Scholar
  25. Rattan SIS (2016) Molecular and cellular basis of aging. In: Malavolta M, Mocchegiani E (eds) Molecular basis of nutrition and aging. Elsevier Academic Press, London, pp 3–9CrossRefGoogle Scholar
  26. Rattan SIS (2018) Biogerontology: research status, challenges and opportunities. Acta Biomed 89:291–301PubMedPubMedCentralGoogle Scholar
  27. Rose MR (1991) Evolutionary biology of aging. Oxford University Press, New YorkGoogle Scholar
  28. Ryff CD, Singer BH (2009) Understanding healthy aging: key components and their integration. In: Bengston VL, Gans D, Putney N, Silverstein M (eds) Handbook of theories of aging. Springer, New YorkGoogle Scholar
  29. Sagner M, McNeil A, Puska P, Auffray C, Price ND, Hood L et al (2017) The P4 health spectrum—a predictive, preventive, personalized and participatory continuum for promoting healthspan. Prog Cardiovasc Dis 59:506–521CrossRefGoogle Scholar
  30. Schroeder SA (2013) Rethinking health: healthier or healthier than? Br J Phil Sci 64:131–159CrossRefGoogle Scholar
  31. Schulkin J (2003) Rethinking homeostasis: allostatic regulation in physiology and pathophysiology. MIT Press, CambridgeGoogle Scholar
  32. Sholl J (2016) Contextualizing medical norms: George Canguilhem’s surnaturalism. In: Giroux E (ed) Naturalism in the philosophy of health: issues and implications. Springer, Dordrecht, pp 81–100Google Scholar
  33. Smirnova L, Harris G, Leist M, Hartung T (2015) Cellular resilience. Altex 32:247–260CrossRefGoogle Scholar
  34. Sterling P (2004) Principles of allostasis: optimal design, predictive regulation, pathophysiology and rational therapeutics. In: Schulkin J (ed) Allostasis, homeostasis, and cost of adaptation. Cambridge University Press, Cambridge, pp 17–64Google Scholar
  35. Truchetet ME, Pradeu T (2018) Rethinking our understanding of immunity: robustness in the tissue reconstruction system. Semin Immunol 26:45–55CrossRefGoogle Scholar
  36. Yates FE (1994) Order and complexity in dynamical systems: homeodynamics as a generalised mechanism in biology. Math Comput Modell 19:49–74CrossRefGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Philosophy and History of Ideas, School of Culture and SocietyAarhus UniversityAarhusDenmark
  2. 2.Laboratory of Cellular Ageing, Department of Molecular Biology and GeneticsAarhus UniversityAarhusDenmark

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